NMNC 2310 FINAL EXAM VERIFIED ACCURATE STUDY
GUIDE
Interventions for the patient in acute mania: Communication - Answers - -Use firm and
calm approach
-Use short and concise explanations
-Remain neutral
-Be consistent
-Set limits and concrete consequences
-Redirect energy to more appropriate channels
Interventions for the patient in acute mania: Structure in a safe milieu - Answers - -
Maintain low level of stimuli
-Provide structured solitary activities with nurse
-When warranted use meds and seclusion to minimize physical harm
-Redirect violent behavior
-Protect patient from giving away money and possessions
Interventions for the patient in acute mania: Nutrition - Answers - -Provide frequent high
calorie drinks and finger foods
-Frequently remind patient to eat
-Monitor I & O, and vital signs
Interventions for the patient in acute mania: Sleep - Answers - -Encourage frequent rest
periods
-Keep patient in areas of low stimulation
-Relaxation techniques at night
Interventions for the patient in acute mania: Hygiene - Answers - -Supervise choice of
clothes
-Give simple step by step reminders
Interventions for the patient in acute mania: Elimination - Answers - -Monitor bowel
habits
-Offer foods and fluids
-Evaluate need for laxative
-Encourage patient to go to bathroom
(Bipolar) Priorities during acute phase - Answers - -Medical stabilization
-Maintaining safety
-Self-care needs
(Bipolar) Priorities during continuation phase - Answers - -Maintain medication
adherence
,-Psychoeducational teaching
-Referrals
(Bipolar) Priorities during Maintenance Phase - Answers - -Prevent relapse-Limit
severity and duration of future episodes
Lithium therapeutic Levels - Answers - -During Initial tx of manic phase : 0.8 to 1.4
mEq/L-Maintenance level range : 0.4 to 1.0 mEq/L-Monitor levels every 2 to 3 days at
initiation of therapy and then every 3 to 6 months
Lithium adverse effects - Answers - Gastrointestinal effects
Tremors
Polyuria
Renal toxicity
Weight gain
Goiter and hypothyroidism
Teratogenesis
Lithium drug interactions - Answers - Diuretics
NSAIDs
Anticholinergic drugs
Lithium toxicity - Answers - > greater than 1.5 mEq/L
Early symptoms
-Diarrhea
-Vomiting
-Drowsiness
-Muscle weakness
-Lack of coordination
Severe symptoms
-Ataxia
-Giddiness
-Tinnitus
-Blurred vision
-Polyuria
Lithium Nursing Administration - Answers - -Monitor lithium levels while undergoing
treatment
-Lithium blood levels should be obtained in the morning, usually 12 hours after the last
dose
-Take with food will help decrease GI distress
-Encourage patients to adhered to laboratory appointments
-Provide nutritional counseling (importance of adequate fluid and sodium intake)
--Maintain diet adequate with sodium and drink to 2 to 3 Liters of water each day
, -Patients should withhold medication and seek medical attention if experiencing
diarrhea, vomiting or excessive sweating
SSRIs adverse effects - Answers - Serotonin Syndrome
CNS Stimulation
Headache
GI upset
Bruxism
Bleeding disorders
Sexual dysfunction
Weight gain
Hyponatremia
Withdrawal syndrome
SSRIs Drug interactions/Contraindications - Answers - -MAOIs
-Antiplatelet & anticoagulants
-TCAs & lithium
Contraindications/Precautions
-Neonatal effects when used during pregnancy
-Teratogenesis
SSRIs pt teaching - Answers - · If taking fiber supplements, take them 2 hours before or
after SSRIs.
· Avoid the use of MAOIs, St. John's Wort, and tryptophan to avoid the increased risk of
developing serotonin syndrome.
· Take medication as prescribed and do not alter dosage amount.
· Report an increase in suicidal thoughts or any extreme changes in mood.
· Do not abruptly discontinue medication; medication must be gradually tapered off for 1
to 2 months to prevent discontinuation syndrome.
· Stress the importance of keeping follow-up appointments with provider.
TCAs adverse effects - Answers - -Sedation
-Orthostatic hypotension
-Anticholinergic effects
-Cardiac toxicity
-Risk for suicide (early treatment)
-Hypertensive crisis
TCA's pt teaching - Answers - · Report to provider if experiencing blurred vision,
agitation, urinary retention, or ataxia.
-Stand/move positions slowly
· Encourage to wear medical alert bracelet or necklace showing diagnosis and list of
current medications.
· Avoid alcohol while taking this medication.
· Do not take TCAs with MAOIs; can cause hyperpyretic crisis.
GUIDE
Interventions for the patient in acute mania: Communication - Answers - -Use firm and
calm approach
-Use short and concise explanations
-Remain neutral
-Be consistent
-Set limits and concrete consequences
-Redirect energy to more appropriate channels
Interventions for the patient in acute mania: Structure in a safe milieu - Answers - -
Maintain low level of stimuli
-Provide structured solitary activities with nurse
-When warranted use meds and seclusion to minimize physical harm
-Redirect violent behavior
-Protect patient from giving away money and possessions
Interventions for the patient in acute mania: Nutrition - Answers - -Provide frequent high
calorie drinks and finger foods
-Frequently remind patient to eat
-Monitor I & O, and vital signs
Interventions for the patient in acute mania: Sleep - Answers - -Encourage frequent rest
periods
-Keep patient in areas of low stimulation
-Relaxation techniques at night
Interventions for the patient in acute mania: Hygiene - Answers - -Supervise choice of
clothes
-Give simple step by step reminders
Interventions for the patient in acute mania: Elimination - Answers - -Monitor bowel
habits
-Offer foods and fluids
-Evaluate need for laxative
-Encourage patient to go to bathroom
(Bipolar) Priorities during acute phase - Answers - -Medical stabilization
-Maintaining safety
-Self-care needs
(Bipolar) Priorities during continuation phase - Answers - -Maintain medication
adherence
,-Psychoeducational teaching
-Referrals
(Bipolar) Priorities during Maintenance Phase - Answers - -Prevent relapse-Limit
severity and duration of future episodes
Lithium therapeutic Levels - Answers - -During Initial tx of manic phase : 0.8 to 1.4
mEq/L-Maintenance level range : 0.4 to 1.0 mEq/L-Monitor levels every 2 to 3 days at
initiation of therapy and then every 3 to 6 months
Lithium adverse effects - Answers - Gastrointestinal effects
Tremors
Polyuria
Renal toxicity
Weight gain
Goiter and hypothyroidism
Teratogenesis
Lithium drug interactions - Answers - Diuretics
NSAIDs
Anticholinergic drugs
Lithium toxicity - Answers - > greater than 1.5 mEq/L
Early symptoms
-Diarrhea
-Vomiting
-Drowsiness
-Muscle weakness
-Lack of coordination
Severe symptoms
-Ataxia
-Giddiness
-Tinnitus
-Blurred vision
-Polyuria
Lithium Nursing Administration - Answers - -Monitor lithium levels while undergoing
treatment
-Lithium blood levels should be obtained in the morning, usually 12 hours after the last
dose
-Take with food will help decrease GI distress
-Encourage patients to adhered to laboratory appointments
-Provide nutritional counseling (importance of adequate fluid and sodium intake)
--Maintain diet adequate with sodium and drink to 2 to 3 Liters of water each day
, -Patients should withhold medication and seek medical attention if experiencing
diarrhea, vomiting or excessive sweating
SSRIs adverse effects - Answers - Serotonin Syndrome
CNS Stimulation
Headache
GI upset
Bruxism
Bleeding disorders
Sexual dysfunction
Weight gain
Hyponatremia
Withdrawal syndrome
SSRIs Drug interactions/Contraindications - Answers - -MAOIs
-Antiplatelet & anticoagulants
-TCAs & lithium
Contraindications/Precautions
-Neonatal effects when used during pregnancy
-Teratogenesis
SSRIs pt teaching - Answers - · If taking fiber supplements, take them 2 hours before or
after SSRIs.
· Avoid the use of MAOIs, St. John's Wort, and tryptophan to avoid the increased risk of
developing serotonin syndrome.
· Take medication as prescribed and do not alter dosage amount.
· Report an increase in suicidal thoughts or any extreme changes in mood.
· Do not abruptly discontinue medication; medication must be gradually tapered off for 1
to 2 months to prevent discontinuation syndrome.
· Stress the importance of keeping follow-up appointments with provider.
TCAs adverse effects - Answers - -Sedation
-Orthostatic hypotension
-Anticholinergic effects
-Cardiac toxicity
-Risk for suicide (early treatment)
-Hypertensive crisis
TCA's pt teaching - Answers - · Report to provider if experiencing blurred vision,
agitation, urinary retention, or ataxia.
-Stand/move positions slowly
· Encourage to wear medical alert bracelet or necklace showing diagnosis and list of
current medications.
· Avoid alcohol while taking this medication.
· Do not take TCAs with MAOIs; can cause hyperpyretic crisis.
